HOSPITAL DAILY MONITORING CHECKLIST (W RITE YES/NO) DATE/TIME

1 . OP D 6 . Di ag nos ti c Fac i l ity

1.1 Reception & Help Desk - Patient guidance, Information

regarding services & Doctor.
6.1 Patho lo gy Lab
1.2 Registration - Availability as per made of staff, 6.11 Staff
stationary, prescription slips, HMIS (Hospital statistics). 6.12 Equipments & their functioning status.

1.3 Senior Citizen Counter display. 6.13 Consumables

1.4 Complaint Box. 6.14 Whether range of investigation is
consistent with the Medical Services
provided.
1.5 Chambers of Doctors & Specialist, Patient's sitting 6.15 Reports - whether being released in time
arrangement, Patient disposal. to O.P.D/Wards.
1.6 Dispensary- Availability of drugs, Pharmacist, duty
roster. 6.2 Radio I ma ging
1.7 Grievance Redressal by RMO/ Superintendent. 6.21 X-Ray/CT Scan Machine & functioning
status.
1.8 Minor O.T. - Dressing material, instruments, sterilised 6.22 Availability and Quality of Fixer
drums, Gloves etc. developer, X-Ray Film.
1.9 Plaster Room, Injection Room- Availability of material 6.23 USG - Functioning status.
& performance status. 6.24 Radiation Safety officer nominated.
1.10 Referral Register 6.25 Reports- whether being released in time to
OPD/Ward.
1.11 Enquire whether Patients are getting Medicine or Not. 6.26 Status of Radiation Protection Protocol,
Badges is being regularly used.
2. Caus al ity 7. Store

2.1 Availability of Doctor, Nurse, compounder, other 7.1 Store Keeper/Pharmacist - Availability.
support staff Duty Roster. CMO daily report.
2.2 Availability of emergency tray having drugs, oxygen, 7.2 Storage of Drugs in order, cleannes.
Ambubag, suction, equipment functioning, support staff,
Duty Roster.
2.3 Status of emergency ward. 7.3 Security status.
2.4 Skill of Medical/paramedical in life saving practices 7.4 Drugs- sample stock check, expiry
emergency ward, emergency Box having drugs stitching (FEFO).
material, dressing material for Disaster.
3. Dis pens ary 8. O.T/IC U
3.1 Availability of sufficient drug stock. 8.1 Anaesthetist- Specialist/ M.O.
8.2 Support staff
3.2 Stock Book entry, Daily expenditure entry verification. 8.3 Functioning status of Equipment.
8.4 Duty Roster, OT checklist, Infection
Control Measures -fumigation / Culture
3.3 Drug dispensing in envelops. 8.5 swabs.
Emergency/OT Drugs/sterilization of
linen/instrument.
4. H.R . s tatus check Atte nda nce 9. La bo ur Roo m
4.1 Medical, Para Medical 9.1 Availability of Staff, Drugs, Five trays.
4.2 Support staff, Behaviour of staff among colleagues and 9.2 Availability & status of Resuscitation
with patient. equipment
5. Ambula nce 9.3 Status of Labour Table, Mattress
Macintosh.
5.1 24x7 Availability & functioning, Diesel, Petrol. 9.4 Cleanliness Status, Availability of dustbins,
water supply etc.
5.2 Driver - Available round the clock.
5.3 Daily Log Book verification.
Checked by : date (Enclose remarks of improvement if any as per Guidelines on
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 HOSPITAL DAILY MONITORING CHECKLIST (W RITE YES/NO) DATE/TIME

10. Wa rds -

10.1 Status of Mattress, Sheets, Drugs. 17. Pat ient' s/ Att e nda nt's feed backs for
10.2 Staff - Regular Rounds by Medical Officer/Specialist to saat risefaocftD
18. C oreyadt r/eM
atomr teunatr. y arra nge ments /
be ensured. Post- mo rte m..
10.3 Record Keeping- Drugs, Case sheet etc. 19. Hosp ital Fur nit ure- woode n, steel,
10.4 Nursing & support staff. 20. H ospitaFurniture
Rusted l Waste M&anremedial age me nt measures
10.5 Enquire patients regarding services behaviour of the 20 .1 Co l le c t io n
staff.
11. House Kee pi ng 20 .2 Se g re g a t ion

11.1 OPD 20 .3 M a in t e n a nc e o f Re c o rd
11.2 Wards 20 .4 T ra ns p o rta t io n

11.3 OT/ICU 20 .5 D is p os al- i f in -h ou s e wh e t h er p rot oc o l is

11.4 L.R. o be sset rruvcetdio. n & Dis p o sa l o f sh a rps.
20 .6 D

11.5 Premises 20 .7 De st ru c t io n & D is in fe c t io n o f rub b e r, g la s s &

Plas t ic s .
11.6 Drainages 20 .8 Co lo u rs c o d e d Bin s a re in p la ce in OPD , in
11.7 Toilets cleanliness, Lights 20 .9 Rwe agrudlsa ,r iC
nhina njegcitniog no rfopoom
ly et ht ce.n e s .

11.8 Toilets for OPD patients, use of Disinfectants. 20 .10 Us e o f pro t e ct iv e ge a r, boo ts , a p ro n e t c by
12. Wate r Supply 21. Owbassteerhvaanndclien g &
s t a ffP. ract ice of I nfe ction
Cont rol Pro tocols .
12.1 Drinking water RO/Aqua guard. 21 .1 In O. T.
12.2 Water Cooler- Maintenance. 21 .2 In I CU
12.3 Overhead tanks 21 .3 In L. R.
12.4 Taps & fittings, Leakages. 21 .4 Ha nd wa sh Pra ct ic e
12.5 Washroom 21 .5 P ro te c t iv e g lo v es , a p ron e t c
12.6 Washbasins
13. Ele ctric Supply 22. R e cord Roo m

13.1 General- Switches, wiring, Lights. 22 .1 C le an l in e ss/ p es ts / Ro den ts

13.2 Generator- Functional status. 22 .2 P ro pe r f i lin g s t oc kin g
13.3 Availability of Electrician during routine/Emergency
Hours.
14. D ie t

14 .1 A v a i la b i lit y o f Sta ff
14 .2 A v a ilab il it y o f Foo d it e ms & Ti min gs o f Fo o d sup p ly.

14 .3 Ut e n sils - Av a ila bi l it y & C le an l in es s .

14 .4 Fo o d Tro lley

14 .5 W a t er s u p ply

14 .6 Ge n era l C lea n l in es s

15 . Ho s p it al S ig na g e , Dis p la y Bo a rd s , Timin g s d is p lay .

16 . Fi re f igh t in g Eq u ip me n t

Checked by : date (Enclose remarks of improvement if any as per Guidelines on

www.health.mp.gov.in)
 HOSPITAL DAILY MONITORING CHECKLIST (W RITE YES/NO) DATE/TIME

REMARKS OF HOSPITAL SUPERINTENDENT/ INCHARGE:

Checked by : date (Enclose remarks of improvement if any as per Guidelines on

www.health.mp.gov.in)